BILL ANALYSIS Ó
AB 2198
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Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
AB 2198 (Levine) - As Amended: April 21, 2014
SUBJECT : Mental health professionals: suicide prevention
training.
SUMMARY : Requires Psychologists, Licensed Marriage and Family
Therapists (LMFTs), Licensed Education Psychologists (LEPs),
Licensed Clinical Social Workers (LCSWs), and Licensed
Professional Clinical Counselors (LPCCs) to complete either 15
or more hours of coursework during a degree program, or six or
more hours of continuing education (CE) coursework as part of
license renewal, in suicide assessment, management and
treatment, depending on the professional's date of graduation.
Specifically, this bill :
For Psychologists :
1)Requires an applicant for licensure as a psychologist, who
began graduate study on or after January 1, 2016, to complete
as a condition of licensure, a minimum of 15 contact hours of
coursework in suicide assessment, treatment, and management
and prohibits the Board of Psychology (BOP) from issuing a
license to a psychologist applicant until the applicant has
met the specified educational requirements.
2)Requires a licensed psychologist, who began graduate study
prior to January 1, 2016, to complete a six-hour continuing
education course in best practices for suicide assessment,
treatment, and management during his or her first renewal
period, as specified, and submit acceptable evidence to BOP of
the person's satisfactory completion of that course, and
prohibits BOP from issuing a license to a psychologist until
the applicant has met the specified educational requirements.
3)Permits CE courses taken in suicide assessment, treatment and
management, to be applied to the 36 hours of approved
continuing education required, as specified.
4)Delays the implementation of the CE requirement until January
1, 2016.
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For Licensed Marriage and Family Therapists :
5)Requires a qualified applicant for licensure as a marriage and
family therapist, who began graduate study on or after January
1, 2016, to complete, as a condition of licensure, a minimum
of 15 contact hours of coursework in suicide assessment,
treatment, and management.
6)Requires a LMFT, who began graduate study prior to January 1,
2016, to complete a six-hour continuing education course in
best practices for suicide assessment, treatment, and
management during his or her first renewal period, as
specified, and submit acceptable evidence to BBS of the
person's satisfactory completion of that course.
7)Permits CE courses taken in suicide assessment, treatment, and
management, to be applied to the 36 hours of approved
continuing education required, as specified.
8)Delays the implementation of the CE requirement until January
1, 2016.
For Licensed Educational Psychologists :
9)Requires an applicant for licensure as an educational
psychologist, who began graduate study on or after January 1,
2016, to complete as a condition of licensure, a minimum of 15
contact hours of coursework in suicide assessment, treatment,
and management and prohibits BBS from issuing a license to an
educational psychologist until the applicant has met the
specified educational requirements.
10)Requires a LEP, who began graduate study prior to January 1,
2016, to complete a six-hour continuing education course in
best practices for suicide assessment, treatment, and
management during his or her first renewal period, as
specified, and submit acceptable evidence to BBS of the
person's satisfactory completion of that course.
11)Permits CE courses taken in suicide assessment, treatment,
and management, to be applied to the 36 hours of approved
continuing education required, as specified.
12)Delays the implementation of the CE requirement until January
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1, 2016.
For Licensed Clinical Social Workers :
13)Requires an applicant for licensure as a clinical social
worker, who began graduate study on or after January 1, 2016,
to complete as a condition of licensure, a minimum of 15
contact hours of coursework in suicide assessment, treatment,
and management and prohibits BBS from issuing a license to a
social worker until the applicant has met the specified
educational requirements.
14)Requires a LCSW, who began graduate study prior to January 1,
2016, to complete a six-hour continuing education course in
best practices for suicide assessment, treatment, and
management during his or her first renewal period, as
specified, and submit acceptable evidence to BBS of the
person's satisfactory completion of that course.
15)Permits CE courses taken in suicide assessment, treatment,
and management, to be applied to the 36 hours of approved
continuing education required, as specified.
16)Delays the implementation of the CE requirement until January
1, 2016.
For Licensed Professional Clinical Counselors :
17)Requires a qualified applicant for licensure as a
professional clinical counselor, who began graduate study on
or after January 1, 2016, to complete, as a condition of
licensure, a minimum of 15 contact hours of coursework in
suicide assessment, treatment, and management.
18)Requires a LPCC, who began graduate study prior to January 1,
2016, to complete a six-hour continuing education course in
best practices for suicide assessment, treatment, and
management during his or her first renewal period, as
specified, and submit acceptable evidence to BBS of the
person's satisfactory completion of that course.
19)Permits CE courses taken in suicide assessment, treatment,
and management, to be applied to the 36 hours of approved
continuing education required, as specified.
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20)Delays the implementation of the CE requirement until January
1, 2016.
EXISTING LAW
1)Requires the director of the Department of Consumer Affairs
(DCA), by regulation, to develop guidelines to prescribe
components for mandatory CE programs administered by any board
within DCA and requires that those guidelines ensure that
mandatory CE is used as a means to create a more competent
licensing population, thereby enhancing public protection.
(Business and Professions Code (BPC) Section 166)
2)Establishes the Psychology Licensing Law which provides for
the licensure and regulation of licensed Psychologists. (BPC
2901 et seq.)
3)Requires an applicant for licensure as a psychologist to
comply with the following requirements:
a) Not be subject to denial, as specified;
b) Possess an earned doctorate degree, as specified;
c) Have engaged for at least two years in supervised
professional experience under the direction of a licensed
psychologist, as specified;
d) Take and pass an examination, as specified; and,
e) Show by evidence satisfactory to BOP that he or she has
completed training in the detection and treatment of
alcohol and other chemical dependency, as specified. (BPC
2914)
4)Requires BOP to develop guidelines for the basic education and
training of psychologists whose practices include patients
with medical conditions and patients with mental and emotional
disorders who may require psychopharmacological treatment and
whose management may require collaboration with physicians and
other licensed prescribers, as specified. (BPC 2914.3(b))
5)Establishes the Licensed Marriage and Family Therapy Act to
regulate marriage and family therapists and interns (BPC
4980.04 et seq.)
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6)Establishes the requirements of educational programs for
applicants for licensure as an MFT, as specified. (BPC
4980.36, 4980.39)
7)Requires each educational institution preparing applicants to
qualify for registration or licensure to notify each of its
students by means of its public documents or otherwise in
writing that its degree program is designed to meet the
requirements, as specified, and certify to the board that it
has so notified its students. (BPC 4980.38)
8)Specifies that an applicant for registration or licensure
submit to the BBS a certification by the applicant's
educational institution that the institution's required
curriculum for graduation and any associated coursework
completed by the applicant meets specified requirements. (BPC
4980.38)
9)Establishes the Licensed Educational Psychologists Practice
Act to regulate educational psychologists. (BPC 4989.10 et
seq.)
10)States the practice of educational psychology is the
performance of any of the following professional functions
pertaining to academic learning processes or the educational
system or both:
a) Educational evaluation;
b) Diagnosis of psychological disorders related to academic
learning processes;
c) Administration of diagnostic tests related to academic
learning processes including tests of academic ability,
learning patterns, achievement, motivation, and personality
factors;
d) Interpretation of diagnostic tests related to academic
learning processes including tests of academic ability,
learning patterns, achievement, motivation, and personality
factors;
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e) Providing psychological counseling for individuals,
groups, and families;
f) Consultation with other educators and parents on issues
of social development and behavioral and academic
difficulties;
g) Conducting psychoeducational assessments for the
purposes of identifying special needs;
h) Developing treatment programs and strategies to address
problems of adjustment; and
i) Coordinating intervention strategies for management of
individual crises. (BPC 4989.14)
11)Requires an LEP seeking to renew his or her license to
certify to BBS, on a prescribed form, completion in the
preceding two years of not less than 36 hours of approved
continuing education in, or relevant to, educational
psychology. (BPC 4989.34)
12)Establishes the Clinical Social Worker Practice Act to
license and regulate LCSWs. (BPC 4991 et seq.)
13)Establishes the licensure requirements for an LCSW and
requires each applicant to furnish satisfactory evidence to
BBS that he or she has complied with specified requirements
including adequate instruction and training in the subjects of
alcoholism and other chemical substance dependency; spousal or
partner abuse assessment, detection, and intervention; human
sexuality, as specified; and, child abuse assessment and
reporting, as specified. (BPC 4996.2 (e-h))
14)Requires an LCSW to complete CE coursework in aging and long
term care, as specified. (BPC 4996.26)
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15)Establishes the Licensed Professional Clinical Counselor Act
to license and regulate professional clinical counselors.
(BPC 4999.10 et seq.)
16)Establishes the licensure requirements for a LPCC and
requires each applicant to furnish satisfactory evidence to
BBS that he or she has complied with specified education and
practicum requirements. (BPC 4999.32)
17)Prohibits the BBC from renewing a LPCC license unless the
applicant certifies to BBS, on a form prescribed by BBS, that
he or she has completed not less than 36 hours of approved CE
in, or relevant to, the field of professional clinical
counseling in the preceding two-years, as specified. (BPC
4999.76)
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of this bill . This bill will require including
Psychologists, LMFTs, LEPs, LCSWs and LPCCs to complete either
15 or more hours of coursework, or six or more hours of
continuing education, related to suicide assessment,
treatment, and management, depending on the date in which the
individual began their graduate degree program. The aim is to
ensure that mental health professionals have adequate training
to deal with potentially suicidal individuals. This bill is
author sponsored.
2)Author's statement . According to the author, "Studies
estimate that 40% of people who die by suicide have had
contact with mental health services within a year of their
death. There is no requirement on the books that mental
health professionals have training in suicide assessment,
treatment and management. Most people would assume that if
[patients need] help with suicide prevention that they should
[seek] a mental health professional who has experience with
suicide assessment, treatment and management. This bill is
necessary to ensure that mental health professionals receive
the appropriate training in suicide assessment, treatment and
management, thereby protecting public health."
3)Suicide prevention . According to information provided by the
Centers for Disease Control, in 2009 suicide ranked as the
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10th leading cause of death of person's ages 10 years and
older, accounting for over 36,000 deaths. In 2011, over
487,700 people with self-inflicted injuries were treated in
U.S. emergency departments, which resulted in an estimated
$41.2 billion in combined medical and work loss costs.
In 2012, the National Action Alliance for Suicide Prevention
released the 2012 National Strategy for Suicide Prevention
(National Strategy). The National Strategy outlines strategic
directions with 13 goals and 60 objectives that are meant to
work together in a coordinated format to help prevent suicide.
Goal number 7 of the National Strategy is to "Provide
training to community and clinical service providers on the
prevention of suicide and related behaviors," including, but
not limited to, professions such as first responders, adult
and child protective service professionals, and health care
providers, including behavioral health care professionals.
The objective of the goal is to "provide training to mental
health and substance abuse providers on the recognition,
assessment, and management of at-risk behavior, and the
delivery of effective clinical care for people with suicide
risk." The objective states that mental health and substance
abuse providers should have the essential foundations of
attitudes, knowledge and clinical prevention skills to address
and reduce suicide risk. In addition, it calls for all
education and training programs, including undergraduate,
graduate and CE, to adopt core education and training
guidelines addressing the prevention of suicide-related
behaviors.
This bill aims to ensure that education for mental health
providers include coursework in suicide assessment, treatment
and management by requiring coursework in this subject area be
completed either during a degree program or through CE,
depending upon the beginning date of their graduate degree
program. In order to provide schools with an opportunity to
revise their curricula if necessary, this bill authorizes
licensees who completed graduate study before January 1, 2016,
to obtain the needed coursework through CE, as approved by BOP
or BBS. For individuals who begin graduate study after 2016,
they will be required to complete the coursework during a
degree program.
4)Need for additional training . According to the report,
Preventing Suicide through Improved Training in Suicide Risk
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Assessment and Care: An American Association of Suicidology
Task Force Unabridged Report Addressing Serious Gaps in Mental
Health Training, one-third of people who die from suicide have
had previous contact with a mental health services within one
year of their death and 20% have had mental health contact
within the last month of their life. The report concludes that
despite the prevalence of patient suicidal behavior and deaths
from suicide, the mental health disciplines have been, at
best, inconsistent in training mental health professionals in
the evaluation and management of suicidal patients.
5)Training standards for mental health professionals . Training
and educational standards for mental health professionals vary
depending on the profession. Psychologists, LMFTS, LCSWs LEP,
and LPCCs are required to meet different educational elements
which are determined by each board and are based on each
professions educational needs and standards. In addition, CE
is often required to maintain an active license, and CE
requirements may be set forth in statute and specified in more
detail through regulations issued by BOP or BBS. However,
each of these regulatory bodies has unique CE requirements and
oversight.
6)Psychologists . Psychologists are regulated by BOP and are not
under the jurisdiction of BBS as are the other mental health
professions (LMFTs, LEPs, LCSWs, and LPCCs). Psychologists
are required to possess an earned doctorate degree in
psychology from an approved or accredited educational
institution. In addition, applicants must complete specified
coursework in spousal or partner abuse assessment, detection
and intervention, and training in the detection and treatment
of alcohol and other chemical substances dependency. All
psychologists seeking licensure renewal must obtain training
in the subject of laws and ethics before they apply to the
practice of psychology in California. Additionally,
psychologists are required to take a specified one-time, CE
course in spousal or partner abuse assessment, detection and
intervention strategies, and a one-time three hour CE course
in aging and long-term care, or show proof to the board of its
equivalent in teaching or practicing experience. A
psychologist may request an exemption from CE requirements if
they meet specified criteria.
7)Licensed Marriage and Family Therapists . Under current law,
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LMFTs are required to complete very specific coursework in
numerous subject areas in order to satisfy licensing
requirements which include: the principals of mental health
recovery-oriented care; methods of service delivery in
recovery-oriented practice environments, among others; and
specific instruction in diagnosis, assessment and prognosis
and treatment of mental disorders. However, there is no
specific requirement for a course to include suicide
assessment. The BBS indicates that this training may already
be included in several degree programs, but is currently not
mandatory. LMFTs must complete several one-time CE
requirements for a total of 36 hours of CE every license
renewal period. However, no CE requirements are currently
specified in this subject matter.
8)Licensed Education Psychologists . In order to qualify to be a
LEP, applicants must possess, at minimum, a master's degree in
psychology, educational psychology, school psychology,
counseling and guidance, or a degree deemed equivalent by BBS.
Applicants must complete three years of full time experience,
or the equivalent, working as a school psychologist.
While LEPs are required to obtain specified degrees and relevant
experience related to psychology, they are currently not
required to take coursework in specified subjects such as
suicide assessment. However, according to BBS, they may
obtain coursework in suicide assessment, treatment and
management as part of an established curriculum from an
approved degree program. In addition, LEPs are required to
obtain 36 hours of CE in subject areas such as the aspects of
the discipline that are fundamental to the understanding or
the practice of educational psychology.
9)Licensed Clinical Social Workers . LCSWs typically diagnose
and treat mental and behavioral health issues. To be
licensed, a person must graduate from an accredited master's
degree program, register with the BBS as an ACSW, and complete
additional required coursework including: alcoholism and other
chemical dependency; spousal or partner abuse assessment,
detection and intervention; human sexuality and child abuse
assessment and reporting, as specified, in addition to
obtaining 3,200 hours of supervised work experience, and
successfully pass specified exams. Currently, there is no
specific course requirement for suicide assessment, treatment,
and management, as prescribed by this bill; however, some
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individuals may receive it during their degree program.
10)Licensed Professional Clinical Counselors . In order to
obtain licensure as an LPCC, an applicant who began graduate
study on or after August 1, 2012, is required to obtain a
master's or doctoral degree from an accredited or approved
institution, which covers counseling or psychotherapy in
context, and includes supervised practicum in specified
content areas. In addition, an applicant must obtain a
minimum of 3,000 post-degree hours of experience supervised by
a LPCC, LMFT, LCSW, psychologist or licensed physician and
surgeon who is certified in psychiatry by the American Board
of Psychiatry and Neurology.
Of the 3,000 hours required, not less than 1,750 hours must
involve direct counseling with individuals or groups in a
clinical mental health counseling setting and 150 hours in a
hospital or community mental health setting. In addition, an
applicant must receive a passing score on the National
Clinical Mental Health Counselor Examination and the
California Law and Ethics Exam, which are taken upon
completion of the supervised hours.
Currently, there is no specific course requirement for suicide
assessment, treatment, and management, as prescribed by this
bill; however, some individuals may receive it during their
degree program.
11)Arguments in support . The American Foundation for Suicide
Prevention, Greater San Francisco Bay Area Chapter, writes in
support, "Having 48,416 Californians attempt suicide in one
year indicates we are not doing enough to identify and treat
those who are struggling. Adoption of [this bill] will go a
long way in helping fellow Californians and reduce the number
of those who contemplate suicide."
12)Arguments in opposition . The National Association of Social
Workers, California Chapter, writes in opposition, "We believe
that a social worker education prepares graduates with
training about suicide prevention. Professionals who work in
areas where they are exposed to suicidal clients have a
variety of CE courses they can choose from to strengthen their
skills. Social work is a very broad field and not all social
workers will pursue their license. We believe that these
courses should be voluntary and professionals should be
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trusted to pursue coursework that will be needed on the job."
13)Questions for committee . This bill provides a one-year delay
for educational institutions to revise their coursework to
include specific education in the suicide assessment,
treatment and management. While many educational institutions
may already include coursework in areas related to suicide,
academic institutions will likely need to revise their
coursework guidelines which may take longer than one-year.
The author may wish to work with academic institutions to
ensure that they are able to meet the coursework requirements
of this bill within one year, as currently required.
14)Previous legislation . SB 747 (Kehoe) of 2011 would have
required physicians and surgeons, physician assistants,
registered nurses, nurse practitioners, licensed vocational
nurses, psychiatric technicians, psychologists, marriage and
family therapists, licensed clinical social workers, and
certified nurse assistants to complete specified CE or
training in cultural competency, sensitivity, and best
practices for providing adequate care to lesbian, gay,
bisexual and transgender (LGBT) persons. This bill was vetoed
by the Governor.
AB 675 (Hagman) of 2011 would have prescribed the content of
all of the CE or competency courses required by any of the
boards under the Department of Consumer Affairs (DCA). This
bill was held in Assembly Business, Professions and Consumer
Protection Committee.
AB 2435 (Lowenthal), Chapter 552, Statutes of 2010, requires
psychologists, LMFTs, LCSWs, and LPCCs to have instruction and
training in the recognition and reporting of suspected elder
and dependent adult abuse as requirements for licensure.
REGISTERED SUPPORT / OPPOSITION :
Support
American Foundation for Suicide Prevention, Greater San
Francisco Bay Area Chapter
California Mental Health Directors Association
Didi Hirsh Mental Health Services
El Camino Hospital
National Alliance on Mental Illness, California
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13 individuals
Association of California Healthcare Districts (2/20/2014
version)
California Catholic Conference, Inc. (2/20/2014 version)
Community Solutions (2/20/2014 version)
Seven individuals (2/20/2014 version)
Opposition
National Association of Social Workers, California Chapter
California Psychological Association
American Association for Marriage and Family Therapy, California
Division
California Association of Marriage and Family Therapists
California Right to Life Committee, Inc. (2/20/2014 version)
Analysis Prepared by : Elissa Silva / B.,P. & C.P. / (916)
319-3301